Provider Demographics
NPI:1578908869
Name:PREMIERTOX 2.0 INC.
Entity Type:Organization
Organization Name:PREMIERTOX 2.0 INC.
Other - Org Name:PREMIERTOX LABORATORY-SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-8854
Mailing Address - Street 1:PO BOX 538512
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8512
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:7333 BARLITE BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1320
Practice Address - Country:US
Practice Address - Phone:210-272-0010
Practice Address - Fax:210-272-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIERTOX 2.0 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory